Face Off II

To secure the airway in the patient described in the last post, we did a retrograde wire intubation. This is one of the most complex intubation techniques, something that even an experienced practitioner may only do a dozen times in his career. It is often reserved for patients who have such distorted or traumatized facial anatomy that it is impossible to introduce even a small flexible camera into the nose or mouth. In our case, the patient's cancer made a standard intubation more complicated so the chief resident and attending decided to do the retrograde wire intubation.

In this technique, a needle is placed through the throat into the windpipe. A thin wire is fed through the needle toward the mouth until the wire comes out of the mouth. Then, a tube can be threaded over that wire back into the trachea. Though simple in description, it's not a small procedure. Luckily, our retrograde wire intubation went incredibly smoothly, and I got to see a rather rare method of accessing the trachea.